CHARLES DOUGLAS BRYAN
Individual Provider (NPI-1)
Active
Social Worker, Clinical
Provider Information
- NPI Number
1689315111- Provider Type
- Individual Provider (NPI-1)
- Status
- Active
Contact & Location
- Address
- 373 W HIGHWAY 39 STE 1, BLACKFOOT, ID, 832215228
- Phone
- (208) 557-9450
- Fax
- (208) 561-7111
Specialties & Taxonomies
Social Worker, Clinical
Primary License: ID #LMSW-27872